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Healthcare Revenue Cycle Management Market Size By Product (Integrated, Standalone), By Function (Claims & Denial Management, Medical Coding & Billing, Eligibility Verification, Payment Remittance), By Deployment (On-Premise, Cloud-Based), By End-use (Hospitals, Physician Office, Diagnostic Labs & Ambulatory Surgical Centers), COVID-19 Impact Analysis, Regional Outlook, Growth Potential, Price Trends, Competitive Market Share & Forecast, 2021 – 2027

  • Report ID: GMI1170
  • Base Year: 2020
  • Report Format: PDF

Industry trends

Healthcare Revenue Cycle Management Market size exceeded USD 98.3 billion in 2020 and is anticipated to grow at a CAGR of over 12.9% from 2021 to 2027. Growing demand for health insurance in countries like the U.S., increasing optimization of healthcare revenue cycle management, and technological advancements are expected to drive the market growth. The impact of COVID-19 on the industry is observed to be a negative one. The pandemic and the measures taken by the governments such as the lockdowns and travel restrictions have considerably proved challenging for the healthcare providers and patients due to the shutdown of elective surgeries and office visits.

Healthcare Revenue Cycle Management Market Overview

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High preference for big data analytics and its integration in healthcare revenue cycle management process will create growth opportunities

Advancements in big data analytics will boost the market expansion during the forecast period. Healthcare revenue cycle management stands to benefit immediately from big data analytics. Big data analytics is a platform that can manage large databases efficiently. The utilization of such software helps healthcare providers to store a large amount of data and substantially reduces operational costs. This helps in increasing the efficiency of healthcare services being provided to the patients. Big data analytics software helps in faster decision-making as it enables efficient data processing and analysis. Based on the data processed by big data analytics and healthcare revenue cycle management solutions, the patient service delivery process is facilitated that enhances the outcomes and positively impacts the patient’s experience.

Big data analytics can handle exploding amounts of medical data, from genomic testing and large imaging studies to billions of payment transactions worldwide. Hospitals in developed countries already use big data analysis and AI applications in the areas of denial prediction, insurance pre-certifications, and coding and billing. By finding and analysing patterns in vast amounts of data using big data analytics and machine learning, healthcare service providers have improved productivity in their healthcare revenue cycle management process.

Rising demand for integrated systems will foster the healthcare revenue cycle management market progression

The integrated segment accounted for USD 79.7 billion in 2020. Integrated healthcare revenue cycle management systems are preferred by large healthcare service providers that find it difficult to process large data bases. These end-to-end systems unite front and back-office data flows, give seamless access to clinical data from electronic health records, and streamline the complete healthcare revenue cycle management process. The rising interest of customers in integrated healthcare revenue cycle management solutions comprising of patient scheduling, medical billing, and electronic health records applications will spur the segment growth during the forecast timeframe.

Growing demand for claims & denial management programs will accelerate the industry expansion

The claims & denial management segment held around 28.5% of revenue share in 2020 led by the increasing awareness amongst population residing in developed countries regarding available reimbursement scenario. Growing interest in reimbursement policies will increase the demand for claim and denial management systems augmenting the industry progression during the forecast timeline.

Increasing preference for cloud-based solutions will push the market demand

The cloud-based segment in the healthcare revenue cycle management market captured more than USD 74.7 billion in 2020. Cloud-based software has relatively high preference as compared to the on-premise software systems as these systems are relatively cost-effective. A large number of players operating in market provide cloud-based solutions. This model also provides ease of operations and updated timely for a better user experience.

Growing adoption of healthcare revenue cycle management solutions in hospitals will propel the industry value

Healthcare Revenue Cycle Management Market Size  

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The hospitals end-use segment accounted for 37% of the market share in 2020. High acceptance of healthcare revenue cycle management software in hospitals to optimize revenue by enhancing management of coding, accounts receivable, claims processing, self-pay collections and insurance follow-ups will stimulate the segment expansion. Use of HRCM software help hospitals with the increasing cash flow that helps them in achieving sustainable financial performance.

Rising healthcare expenditure in North America will impel the market growth

North America Healthcare Revenue Cycle Management Market

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North America dominated the healthcare revenue cycle management market and captured over 47% of revenue share in 2020. The growth is attributed to the notable changes in regulations that have positively influenced the organization, finances, and delivery of healthcare services. Furthermore, the increasing number of hospitalizations in the region will in turn fuel the need for healthcare revenue cycle management solutions thereby driving the regional growth. Moreover, the growing prevalence of chronic diseases such as diabetes, cancer, and others escalate the demand for healthcare services such as surgeries that subsequently increases healthcare expenditures. In such cases, U.S. and Canada being developed economies adopt technologically upgraded software. Also, Medicaid and Medicare providers implement various policies that assure affordable healthcare services in the region thereby increasing the overall industry revenue.

Ongoing innovation by leading market players have helped them capture larger revenue share

Some of the prominent companies operating in the market include Accretive Health (R1 RCM), AGS Health Inc., AllScripts, Athenahealth CareCloud Corporation, Cerner Corporation, Conifer Health Solutions, Change Healthcare (Emdeon)    , Experian Information solutions, Inc., Gebbs Healthcare Solutions, McKesson Corporation, Optum (The Advisory Board Company), and SSI group among others. These industry participants are implementing various growth strategies to sustain competition and secure substantial position in the market.

Some of the recent industry developments:

  • In January 2021, Allscripts collaborated with Microsoft, ARC Innovation Center & MATTER to discover new innovation in healthcare IT solution. This collaboration of three companies is set to accelerate their business portfolio including healthcare revenue cycle management solutions.
  • In August 2020, CareCloud announced a partnership with Lake Health Alliance to expand the delivery of software & services. This strategic move helped the company to expand their customer base and profit.

The healthcare revenue cycle management market research report includes an in-depth coverage of the industry with estimates & forecast in terms of revenue in USD from 2016 to 2027, for the following segments:

Market, By Product, 2016-2027 (USD Million)

  • Integrated
  • Standalone

Market, By Function, 2016-2027 (USD Million)

  • Claims & Denial Management 
  • Medical Coding & Billing
  • Eligibility Verification
  • Payment Remittance
  • Others

Market, By Deployment, 2016-2027 (USD Million)

  • On-Premise
  • Cloud-Based

Market, By End-use, 2016-2027 (USD Million)

  • Hospitals
  • Physician Office
  • Diagnostic Labs & Ambulatory Surgical Centers
  • Others

The above information is provided for the following regions and countries:

  • North America
    • U.S.
    • Canada
  • Europe
    • UK
    • Germany
    • France
    • Italy
    • Spain
    • Russia
  • Asia Pacific
    • Japan
    • China
    • India
    • South Korea
    • Australia
  • Latin America
    • Brazil
    • Mexico
    • Argentina
  • Middle East & Africa
    • Saudi Arabia
    • UAE
    • South Africa
Authors: Sumant Ugalmugle, Rupali Swain

Frequently Asked Questions (FAQ) :

Global market size was over USD 98.3 billion in 2020 and will expand at a CAGR of over 12.9% up to 2027 owing to the higher preference for health insurance and the surge in technological advancements.

The overall industry share from the integrated product segment had reached around USD 79.7 billion in 2020 and will grow substantially with demand from large healthcare service providers to process large databases.

The cloud-based healthcare revenue cycle management segment surpassed USD 74.7 billion in 2020 driven by the increasing demand for cost-effective solutions.

Hospitals held more than 37% of the market share during 2020 and will grow with a higher need to optimize revenue in these facilities.

North America market accounted for over 47% of revenue share in 2020 and will see expansion with the notable changes in regulations and the rising preference for organization, finances, and delivery of healthcare services.

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Premium Report Details

  • Published Date: Jul 2021
  • Companies covered: 16
  • Tables & Figures: 251
  • Countries covered: 19
  • Pages: 171

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